Week 5 Nurs 370

Visual acuity develops from birth through. . .

Early childhood

A toddler is diagnosed with acute otitis media and prescribed antipyretics and numbing ear drops. Which instruction is most important to teach the parents about treatment? how to administer the ear drops option of using heat or cool compresses for comfort importance of administering antibiotics as prescribed option of administering acetaminophen or ibuprofen as needed

How to administer the ear drops

Periorbital cellulitis tx

IV antibiotics

The nurse is educating the parents of a 4-year-old boy who has been diagnosed with amblyopia ("lazy eye"). Which comment provides information most helpful for the parents to know? "Surgery can provide fast recovery." "Amblyopia is often preventable." "It's good you didn't wait until age 7." "Give him a prize when he wears the patch."

"Give him a prize when he wears the patch"

Vision impairment in children refers to acuity between 20/60 and 20/200 in the better eye on examination

20/60 and 20/200 in the better eye on examination

The nurse in the health care clinic receives a telephone call from the mother of a child who reports that an insect has somehow flown into the child's ear. The mother reports that the child is complaining of a buzzing sound in the ear. Which priority instruction should the nurse provide to the mother? 1.Report to the clinic immediately. 2.Irrigate the ear with diluted alcohol. 3.Use tweezers to try to remove the insect. 4.Use a flashlight to coax the insect out of the ear.

4.Use a flashlight to coax the insect out of the ear.

Vision continues to develop until age. . .

7

Nearsightedness

A condition in which nearby objects are seen more clearly than distant objects because distant objects focus in front of the retina

Astigmatism

A condition in which the eye does not focus properly because of uneven curvatures of the cornea

Chalazion

A nodule or cyst, usually on the upper eyelid, caused by obstruction in a sebaceous gland

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections? The use of cotton swabs, which can damage the eardrum Swimming and other water activities Eustachian tubes that are long and narrow in children Bacteria entering through the eustachian tube

Bacteria entering through the eustachian tube

Types of conjunctivitis

Bacterial: most dangerous. purulent discharge Viral: watery discharge. most common. lymphadenopathy, tearing Allergic: most annoying. watery discharge, itching

Hyphema

Blood in the anterior chamber of the eye Refer to ophthalmologist

Examples of refractive errors

Nearsightedness, farsightedness

Conjunctivitis

Pink eye Can be caused by a virus, bacteria or allergy

Stye

Small purulent infection of sebaceous gland of eye treated with hot compresses and surgical incision; also called hordeolum

Tympanometry

The use of air pressure in the ear canal to test for disorders of the middle ear

Why are pediatric clients more likely to get eye injuries?

There eyes occupies larger space

To decrease edema in the child with a black eye (simple contusion), instruct the parent to

apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, and continue to repeat the cycle as often as possible during the first 24 hours.

A child has recently been diagnosed with cataracts. The treatment for cataracts is: 1. eye drops to lower the pressure. 2. surgery. 3. wearing a patch until the cloudiness clears. 4. there is no treatment for childhood cataracts.

2. surgery

Common laboratory and diagnostic tests for ears/eyes

- Culture of the eye or ear discharge - Tympanic fluid culture - Tympanometry

Cataracts symptoms

-Progressive blurring of vision over years -Needing increased light to see clearly -Decreased night vision -Poorly visualized fundus on exam (lost red reflex)

Levels of hearing loss

0-20db: normal 20-40db: mild loss 40-60db: mod loss 60-80db: sev loss >80db: profound loss

The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided? 1. "It's an overgrowth of retinal blood vessels." 2. "This can be genetic or acquired." 3. "This is caused by silver nitrate." 4. "The liquid inside the eye can't drain."

1. "It's an overgrowth of retinal blood vessels"

A 4-year-old child is diagnosed with otitis media. The mother asks the nurse about the causes of this illness. Which risk factors should the nurse include in response to this mother? Select all that apply. 1.Bottle-feeding 2.Household smoking 3.A history of urinary tract infections 4.Exposure to illness in other children 5.Congenital conditions such as cleft palate

1.Bottle-feeding 2.Household smoking 4.Exposure to illness in other children 5.Congenital conditions such as cleft palate

The school age child has been diagnosed with astigmatism. The parents state, "I never knew our child had trouble seeing at a distance." How should the nurse respond? "I am surprised this was never discovered during a vision screening exam." "Well, all that is important now is that glasses will help astigmatism." "Sometimes it is difficult to know when a child is nearsighted unless the child notices difficulty seeing at distances." "Astigmatism does not mean being nearsighted. It is actually a curvature of the cornea that causes blurry vision."

"Astigmatism does not mean being nearsighted. It is actually a curvature of the cornea that causes blurry vision."

An infant is born with congenital glaucoma. The infant is scheduled for surgery to relieve this condition at age 2 days. Which prescription should the nurse question for the infant? 1. A preoperative antibiotic 2. A preoperative injection of atropine 3. Arm restraints to be applied after surgery 4. Nothing by mouth (with intravenous therapy) prior to surgery

2. A preoperative injection of atropine

The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision? 1. Nystagmus 2. Exotropia 3. Diplopia 4. Amblyopia

4. Amblyopia

Signs and symptoms of conjunctivitis

Redness Edema Tearing Discharge Eye pain Itching of the eyes

The nurse is caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder? 1. administering antibiotics IV as ordered 2. applying heated Aqua pad to site 3. monitoring for increased intracranial pressure 4. administering morphine sulfate as ordered

1. administering antibiotics IV as ordered

Nystagmus

Involuntary rapid eye movements

When teaching a parent about amblyopia, it would be most important to explain that: 1. if the child is not treated, he or she is likely to resent it later on. 2. amblyopia is a rapid irregular movement of the eye. 3. amblyopia is correctable if the child is properly treated before 6 years of age. 4. amblyopia can result from a refractive error in one eye.

3. amblyopia is correctable if the child is properly treated before 6 years of age.

The nurse is assessing a 13-year-old boy with an eye injury. The nurse determines that evaluating pupillary response to light and accommodation is not appropriate based on the suspicion of a: corneal abrasion. foreign body. scleral hemorrhage. simple contusion.

Scleral hemorrhage

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? Most of these conditions will spontaneously resolve. Once the child is 6 to 9 months old a specialist will be able to drain the duct. Antiviral therapy can be prescribed to manage this condition. Over-the-counter drops can be used sparingly.

Most of these conditions will spontaneously resolve.

A nursing student is doing a clinical rotation on a pediatric floor and is learning about normal growth and development. What can impact normal growth and development? Select all that apply. Interference with vision Education of the mother Education of the father Number of siblings Interference with hearing

Interference with vision Interference with hearing

A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent? Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours. Administer acetaminophen if needed for pain. Assure the parent that the scleral hemorrhages will resolve. Refer the child to an ophthalmologist for further evaluation.

Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.

Otitis externa

Swimmer's ear Inflammation and infection of the outer ear

Premature infants are at high risk for visual deficits. . .

Retinopathy of prematurity

Signs of toddler visual impairment

Rubs, shuts and covers eyes; squints and blinks frequently; holds objects close or sits close to television; bumps into objects,

Indications for patching

Strabismus, amblyopia, any other eye condition that results in one eye being weaker than the other

A young child in the clinic reports pain and has redness on the lid of the right eye. Upon further examination, the nurse notices swelling in the preauricular lymph node along with tenderness. What should the nurse suspect? Cellulitis Stye Chalazion Conjunctivitis

Stye

Examples of eyelid lesions

Stye, chalazion, blepharitis

The nurse is performing the intake assessment of a 6-month-old in the pediatrician's office. The nurse alerts the physician that the child is showing signs of hearing loss based on what assessment findings? Select all that apply. The parent reports that the infant does not respond when the doorbell in their house is rung. The infant does not turn the head when the nurse stands next to the infant and calls their name. The parent reports that the infant does not wake up when the siblings are being loud during nap time. The child is not making any babbling sounds and the parent reports the child never does. The nurse dropped a metal tray in the room and the infant did not react.

The child is not making any babbling sounds and the parent reports the child never does. The nurse dropped a metal tray in the room and the infant did not react. The parent reports that the infant does not wake up when the siblings are being loud during nap time. The infant does not turn the head when the nurse stands next to the infant and calls their name

Amplyopia

Lazy eye Most common cause of vision loss in children

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision? "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." "He might be suffering from hyperopia and probably will need glasses now." "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school." "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

The nurse is caring for a toddler who is scheduled to have myringotomy tubes placed. Which statement by the child's parents indicates a lack of understanding? "My child should only shower with ear plugs in place." "Swimming is permissible only with ear plugs in place." "The tubes tend to fall out in 6 to 12 months." "Hearing loss after the tubes are placed may be permanent."

"Hearing loss after the tubes are placed may be permanent."

On assessment during a well-baby visit, the nurse notes that a 6-month-old infant has crossed eyes. Which interpretation would the nurse make based on this finding? 1.The condition will resolve without treatment. 2.The condition is normal up to the age of 2 years. 3.Surgical intervention may be necessary to realign weak eye muscles. 4.Once the child begins to read, eye muscles strengthen and the condition will resolve.

3. Surgical intervention may be necessary to realign weak eye muscles.

The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification? 1. "Our child will probably have a black eye for at least a couple of weeks." 2. "The blood in the white part of the eye is normal with this type of injury." 3. "I will need to apply heat to the eye four times a day." 4. "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes."

"I will need to apply heat to the eye four times a day."

A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? "It's just a medical term that means an infection of the middle ear." "There is an infection somewhere in the ear canal and their is fluid in the canal." "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." "It would probably be best if you talked to the doctor again about the diagnosis."

"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present."

The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention? 1. "Don't use anything that touches her face." 2. "This could have started with a head cold." 3. "Use all the medication as directed." 4. "Place the ointment inside the lower eyelid."

1. "Don't use anything that touches her face."

The nurse is providing care to a child admitted for acute otitis media. What is the nurse's priority concern for this child? 1.Acute pain 2.Problems with skin integrity 3.Risk for interrupted breathing patterns 4.Mucous membrane dryness and cracking

1. Acute pain

A 1-year-old comes to the clinic for a routine visit. The eye examination reveals an enlarged, edematous, and hazy cornea. The child appears sensitive to light. What should the nurse suspect? 1. Infantile glaucoma 2. Stye 3. Conjunctivitis 4. Cataract

1. Infantile glaucoma

In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which condition does the nurse suspect? 1. Lack of depth perception (stereopsis) 2. Diplopia 3. Refractive error 4. Lack of accommodation

1. Lack of depth perception (stereopsis)

The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis? 1. Recently helped clean the basement 2. Family history of conjunctivitis 3. Recent upper respiratory infection 4. Exposure to infective agents

1. Recently helped clean the basement

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority? 1. ensuring the protective eye patch is securely in place 2. instructing parents about using protective sunglasses 3. explaining to the parents about patching the eye as therapy 4. teaching the family how to use antibiotic eye drops

1. ensuring the protective eye patch is securely in place

Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made by the parents, indicates understanding of the instructions provided? 1."Administer the antibiotics until they are gone." 2."Administer the antibiotics if the child has a fever." 3."Administer the antibiotics until the child feels better." 4."Begin to taper the antibiotics after 3 days of a full course."

1."Administer the antibiotics until they are gone."

A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply. 1.Provide a soft diet. 2.Position the child on the left side. 3.Administer an antihistamine twice daily. 4.Irrigate the right ear with normal saline every 8 hours. 5.Administer ibuprofen for fever every 4 hours as prescribed and as needed. 6.Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy.

1.Provide a soft diet. 5.Administer ibuprofen for fever every 4 hours as prescribed and as needed. 6.Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy.

The nurse is caring for a 2-year-old child with an ear infection who requires the administration of antibiotic eardrops. The nurse observes the mother administering the eardrops to the child. Which observation by the nurse indicates that the mother is performing the procedure correctly? 1.The mother pulls the earlobe up and back. 2.The mother pulls the earlobe down and back. 3.The mother holds the child in a sitting position. 4.The mother must wear gloves to administer the medication.

1.The mother pulls the earlobe down and back.

The primary health care provider prescribes patching for a child with strabismus of the right eye, and the nurse instructs the mother regarding this procedure. What should the nurse include in the instructions? 1.Place the patch on both eyes. 2.Place the patch on the left eye. 3.Place the patch on the right eye. 4.Alternate the patch from the right to the left eye hourly.

2.Place the patch on the left eye.

The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition? 1. The child has difficulty hearing. 2.The child consistently tilts the head to see. 3.The child does not respond when spoken to. 4.The child consistently turns the head to hear.

2.The child consistently tilts the head to see.

The nurse has a prescription to give eardrops to a 5-year-old child. Which position should the nurse use to pull the pinna of the ear? 1.Upward and outward 2.Upward and backward 3.Downward and outward 4.Downward and backward

2.Upward and backward

The nurse provides discharge instructions to the mother of a child following a myringotomy with insertion of tympanoplasty tubes. Which statement by the mother indicates the need for further teaching? 1."My child should not swim or dive in deep water." 2."I need to prevent my child from blowing the nose." 3."My child can swim in the lake or pool as long as the water is not too deep." 4."I will put Vaseline on cotton balls and place them in my child's ears before a bath."

3."My child can swim in the lake or pool as long as the water is not too deep."

A 10-year-old child complains of ear pain that is aggravated by palpation of the auricle. A foul-smelling, tenacious yellow discharge is noted in the ear canal, and the child is diagnosed with acute otitis externa. In providing information to the child and parent, the nurse emphasizes which information? 1.Dizziness is common with this disorder. 2.Cotton-tipped applicators should be used to clean the ears. 3.Nothing smaller than the child's elbow should be placed in the ear. 4.Biannual ear testing must be done by a special primary health care provider.

3.Nothing smaller than the child's elbow should be placed in the ear.

The nurse is teaching parents of a 9-year-old girl about the importance of wearing the prescribed glasses. Which subject is least important to promoting compliance? 1. getting scheduled eye examinations on time 2. checking condition and fit of glasses monthly 3. watching for signs that prescription needs changing 4. encouraging the use of eye protection for sports

4. encouraging the use of eye protection for sports

An adolescent client is diagnosed with conjunctivitis, and the nurse provides information to the client about the use of contact lenses. Which client statement indicates the need for further information? 1. "I should obtain new contact lenses." 2."I should not wear my contact lenses." 3."My old contact lenses should be discarded." 4."My contact lenses can be worn if they are cleaned as directed."

4."My contact lenses can be worn if they are cleaned as directed."

The mother arrives at a well-baby clinic with her 1-month-old infant. She expresses concern because one of the infant's eyes appears to be crossed. What is the nurse's best response? 1."The infant will probably need surgery." 2."This condition is probably permanent." 3."It requires monitoring because the other eye may do the same thing." 4."This is normal in the young infant but should not be present after the age of about 4 months."

4."This is normal in the young infant but should not be present after the age of about 4 months."

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract? Edema of the eyelids Absence of the red reflex Excess watering of the eyes Sclera appears to be blue

Absence of the red reflex

Common drugs for ear/eye disorders

Antibiotics: tx for bacterial infections (acute otitis media, otitis externa, conjunctivitis) Antihistamines: block histamine reaction (allergic conjunctivitis) Analgesics: Pain relief (otitis media, otitis externa)

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan? Assess vision to determine functional capability. Assess the child's ability to convey information. Explain botulinum injection procedure and risks. Teach parents to make vinegar and alcohol eardrops.

Assess the child's ability to convey information

The nurse is caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child? Assessing the child for asymmetric corneal light reflex. Observing for rubbing, shutting the eyes, or squinting. Referring the child to the local district of early intervention. Teaching the parents to check how the child's glasses fit.

Assessing the child for asymmetric corneal light reflex.

A cloudy cornea indicates the presence of

Cataract

Cataracts

Clouding of the lens of the eye or its surrounding transparent membranes.

Types of delayed-onset hearing loss

Conductive hearing loss Sensorineural hearing loss Mixed hearing loss

Types of infectious diseases of the eye (4)

Conjunctivitis Nasolacrimal duct obstuction Eyelid lesions Periorbital cellulitis

Strabismus

Crossed eyes Exotropia: eyes go outward Esotropia: eyes turn inward Tx: Patching, corrective lenses

Refractive errors

Defects in the bending of light as it enters the eye, causing an improper focus on the retina

The nurse is preparing a care plan for the school-age child with a congenital hearing loss of 60 to 80 dB. Which nursing diagnoses should the nurse include on the care plan for this child? Select all that apply. Delayed growth and development Impaired verbal communication Pain Risk for injury Risk for infection

Delayed growth and development Impaired verbal communication Risk for injury

Signs of infant visual impairment

Dull, vacant stare Does not fix and follow Does not make eye contact Unaffected by bright light Does not imitate facial expression

Nasolacrimal duct obstruction

Failure of complete canalization - obstruct tear flow, distally at Hasners valve (Infectious)

T or F: Color discrimination is complete in childhood

False

T or F: Retinal vascularization in complete in childhood

False

Pressure-equalizing (PE) tubes indications

Frequent ear infections

What is the single most important factor to reduce the spread of viral or bacterial conjunctivitis?

Hand washing

Glaucoma

Increased intraocular pressure Treat with surgery

Signs and symptoms of infantile glaucoma

Infant keeping eyes closed Corneal enlargement and clouding Enlarged eyes Photophobia Tearing Eyelid squeezing or spasm

A 1-year-old female has been diagnosed with her fourth ear infection since birth. The nurse understands that children are more susceptible to ear infections than adults because of which anatomical difference? Infants have long Eustachian tubes. The Eustachian tubes of infants are in a slanted position. Infants have horizontally placed Eustachian tubes. Infants have narrow Eustachian tubes.

Infants have horizontally placed Eustachian tubes.

Blepharitis

Inflammation of the glands and eyelash follicles along the margin of the eyelids

Retinopathy of prematurity

Retinal tissue is replaced with fibrous tissue due to using high levels of oxygen therapy in premature babies with immature lungs

Risk factors for retinopathy of prematurity

Low birthweight Early gestational age Sepsis High light intensity Hypothermia

In childhood, placement of eustachian tubes and enlarged adenoids make ears. . .

More prone to infection Bacteria enters the eustachian tubes

Factors increasing the risk for developing visual impairment

Prematurity Developmental delay Genetics Fam history African American Eye injury Diabetes, HIV Chronic corticosteroid use

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? prevention and treatment of otitis media tendency to act silly in the classroom suddenly doing poorly in school playing the radio loudly

Prevention and treatment of otitis media

A child diagnosed with conjunctivitis is being seen in the pediatric clinic. Which statements are correct regarding conjunctivitis? Select all that apply. Purulent drainage is a common symptom. Warm compresses are used to remove crusts that form on the eyes. It is highly contagious. It is most often caused by a virus. Treatment is symptomatic.

Purulent drainage is a common symptom Warm compresses are used to remove crusts that form on the eyes It is highly contagious

The nurse is discussing the ears and hearing in a child with a group of peers. Which statement is most accurate related to this topic? Most children do not have acutely developed hearing until the age of 5 years. The eustachian tube in the infant is straighter and wider than in the adult. The infant usually responds to sounds around the age of 6 months. The eardrum is located between the middle and the internal ear.

The eustachian tube in the infant is straighter and wider than in the adult.

The nurse is providing teaching to the parents of an infant diagnosed with nasolacrimal duct obstruction. The parents are to massage the nasolacrimal duct daily. The parents correctly demonstrate the procedure by performing massage in what order?

The parents perform hand hygiene. The parents use the forefinger or little finger to push on top of the bone. The parents use the finger to gently push in and up. The parents gently push downward along the side of the nose.

T or F: Hearing is intact at birth

True

A 10-year-old client has just been treated for otitis externa and now the nurse is teaching the boy and his parents about prevention. Which recommendation should the nurse include?

Using a hair dryer on cool to dry the ears

Acute otitis media

Usually associated with an upper respiratory infection and is most commonly seen in young children

Corneal abrasion

an injury, such as a scratch or irritation, to the outer layers of the cornea

The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed? decreased ability for the child to hear improvement of the child's language and speech development constant fluid draining from the child's ears slow increases in language development

improvement of the child's language and speech development

Increased AOM in young children is due to

short length and horizontal positioning of the Eustachian tube, limited response to antigens, and lack of previous exposure to common pathogens